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Community-Based System Dynamics User Guide Version 1.0 Brian J. Biroscak, PhD, MS, MA Peter S. Hovmand, PhD
Preface • User guide to illustrate doing system dynamics in community settings • Evolved over several years working with a community committee • Designed to be used in tandem with book: “Community Based System Dynamics”
Acknowledgements (1) • Colorectal Cancer Prevention Community Committee (Tampa Bay area, Florida, USA) • Florida Prevention Research Center, University of South Florida (Tampa, Florida, USA) • Brown School Social System Design Lab, Washington University in St. Louis (St. Louis, MO, USA)
Acknowledgements (2) • This user guide is a product of a Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Number, U48DP005024-01(-02)(-03)(-04), from the Centers for Disease Control and Prevention. The findings and conclusions in this guide are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Contents 1. Introduction to CBSD 2. Group Model Building and CBSD Process 3. Engaging Communities 4. Problem Scoping and Identification 5. Core Modeling Team Planning, Training
6. Group Model Building Workshops and Facilitation 7. Model Refinement, Integration, Formulation, Analysis 8. Implementation and Evaluation
Chapter 1 “Introduction to Community-Based System Dynamics”
Why Community-Based System Dynamics (CBSD)? • CBSD is a participatory method for involving communities in the process of understanding and changing systems from the perspective of system dynamics (Hovmand, 2014). • System dynamics is the use of informal causal maps and formal causal models with computer simulation to uncover and understand endogenous sources of system behavior (Richardson, 2011).
The basic element of system structure is the feedback loop… + (R)
+ “CHICKENS”
…This one is a “positive” or “reinforcing” feedback loop.
TIME
Loops of effects interact with one another, making traditional diagnosis quite difficult… +
-
(R)
+ …Such as with this “negative” or “balancing” feedback loop (B), which may slow or reverse growth.
FARM SIZE
(B)
+ “CHICKENS”
TIME
Why CBSD (cont.)? “When well-meaning people can’t see it the same way” (Seth Godin)
• Q: “What if I already see the system and recognize the actions needed to better manage the system?” • A: You will have trouble persuading others to follow unless their mental models change.
Surface system insights
Implicit models
Explicit models There is a system The components of a system
How the components are related through feedback Where one could intervene
Deep system insights
What is the generic structure Where are the leverage points Why do things happen Credit: P.S. Hovmand, WUSTL
Surface system insights
Implicit models
Explicit models There is a system The components of a system
How the components are related through feedback Mental models
Where one could intervene
Deep system insights
What is the generic structure Where are the leverage points Why do things happen
Surface system insights
Implicit models
Explicit models There is a system The components of a system
How the components are related through feedback Mental models
Where one could intervene
Deep system insights
What is the generic structure Where are the leverage points Why do things happen
Surface system insights
Implicit models
Explicit models There is a system The components of a system
How the components are related through feedback Mental models
Where one could intervene
Deep system insights
What is the generic structure Where are the leverage points Why do things happen
Surface system insights
Implicit models
Explicit models There is a system The components of a system
How the components are related through feedback Mental models
Where one could intervene
Deep system insights
What is the generic structure Where are the leverage points Why do things happen
CBSD Is About: • Building public constituency to support interventions that address root causes of dynamic problems • Helping communities co-create models that lead to system insights and recommendations Credit: P.S. Hovmand, WUSTL
Contents 1. Introduction to CBSD 2. Group Model Building and CBSD Process 3. Engaging Communities 4. Problem Scoping and Identification 5. Core Modeling Team Planning, Training
6. Group Model Building Workshops and Facilitation 7. Model Refinement, Integration, Formulation, Analysis 8. Implementation and Evaluation
Chapter 2 “Group Model Building and CBSD Process”
Group Model Building (GMB) • Method of involving participants and other stakeholders in the modeling process: Problem conceptualization Formulation Intervention analysis Implementation
• Reasons for using GMB – – – –
Sharing of insights Developing consensus Design for implementation “Dignity of risk”
Credit: P.S. Hovmand, WUSTL
GMB Scripts • Divergent activities – e.g., “Graphs over Time”
• Convergent activities – e.g., “Parameter Estimation”
• Evaluative activities – e.g., “Dots”
• Presentation activities – e.g., “Concept Model” https://en.wikibooks.org/wiki/Scriptapedia
Three Phases of a CBSD Project Phase*
Activities
Problem discovery or “scoping”
ID dynamic problem to be modeled Assess suitability for system dynamics Develop one-page project description
Core modeling team planning
Design group model building process Develop agenda, scripts for each session Training, rehearsal
Group model building with participants
Qualitative modeling Quantitative modeling (simulation) Transfer of ownership
* Each phase is described more specifically with its own chapter (Hovmand, 2014).
Contents 1. Introduction to CBSD 2. Group Model Building and CBSD Process 3. Engaging Communities 4. Problem Scoping and Identification 5. Core Modeling Team Planning, Training
6. Group Model Building Workshops and Facilitation 7. Model Refinement, Integration, Formulation, Analysis 8. Implementation and Evaluation
Chapter 3 “Engaging Communities”
Engaging Communities • Many ways to define “community” (e.g., neighborhoods, schools, organizations). • Engagement fundamentally about building a shared language around a model(s). • Two basic approaches to demo GMB: – Engaging with the “Graphs over Time” script – Engaging with the “Concept Model” script
“Graphs over Time” Script 1. Facilitator demo: how to draw graphs over time 2. Participants draw one variable over time per piece of paper 3. Participants then share graphs with group (round robin) 4. Wall-builder clusters graphs on wall/board 5. Participants talk about clusters and problem characterization
https://en.wikibooks.org/wiki/Scriptapedia
Example: “Graphs over Time”
Example: “Graphs over Time”
Example: “Graphs over Time”
Engaging Communities • Both “Graphs over Time” and “Concept Model” exercises provide ways to share: – What a group model building exercise is; – What we mean by a model; and – How their participation can lead to a model.
Contents 1. Introduction to CBSD 2. Group Model Building and CBSD Process 3. Engaging Communities 4. Problem Scoping and Identification 5. Core Modeling Team Planning, Training
6. Group Model Building Workshops and Facilitation 7. Model Refinement, Integration, Formulation, Analysis 8. Implementation and Evaluation
Chapter 4 “Problem Scoping and Identification”
Critical Questions to Consider Question
How This Is Answered
What is the problem? Is it dynamic?
Drawing a reference mode with the desired and feared behavior over time
What kind of problem is it?
Primary diagnosis as a learning, coordination, analysis, or transformation problem (or some combination thereof)
Does the system involve feedback mechanisms?
Drawing a diagram of the system that involves one or more feedback loops
What kinds of insights would help solve the problem?
Identify types of model-based insights that will help solve the problem
What is the purpose of the model?
Write a model project description
What value would the model add?
Compare modeling to current tools Credit: P.S. Hovmand, WUSTL
What Kind of Problem Is It?
Credit: P.S. Hovmand, WUSTL
What Kinds of Insights Would Help Solve the Problem?
Modeling Project Description (1)
Modeling Project Description (2)
Modeling Project Description (3)
Contents 1. Introduction to CBSD 2. Group Model Building and CBSD Process 3. Engaging Communities 4. Problem Scoping and Identification 5. Core Modeling Team Planning, Training
6. Group Model Building Workshops and Facilitation 7. Model Refinement, Integration, Formulation, Analysis 8. Implementation and Evaluation
Chapter 5 “Core Modeling Team Planning, Training, and Capacity Building”
Forming a Core Modeling Team (CMT) CMT primary task: To design the GMB workshop or set of workshops over the next four to five 2-hour meetings. Generally a small team of 5-7 people. Desired CMT member features: • Knowledge of community • Knowledge of stakeholders • Know the local language/customs • Sense of meaningful deliverables • Understand local power dynamics • Willing to ask tough questions • Process tolerant
CMT Meetings
Description
1. Introducing CMT to system dynamics and GMB process
Consists of introduction to system dynamics, GMB, role of CMT, and process for planning GMB workshops
2. Developing process maps
CMT focuses on identifying stakeholder groups and sequence of GMB workshops
3. Developing an agenda
CMT develops a detailed agenda for each GMB workshop
4. Adapting and developing GMB scripts
CMT drafts a facilitation manual, GMB scripts
5. Training Planning 6. Rehearsal Credit: P.S. Hovmand, WUSTL
Community-Based Prevention Marketing for Systems Change Process Map: Modeling Project Project Period: June 2015-August 2017 Months Stakeholders
Planning and training
Conceptual mapping
Model formulation
Model testing
Model refinement
Policy analysis
Policy analysis cont.
Transfer of ownership
06/15-08/15
12/15-02/16
03/16-05/16
06/16-08/16
09/16-11/16
12/16-02/17
03/17-05/17
06/17-8/17
09/15-11/15
Community members (CCC)
C
D
Practitioners and policymakers (LT, ACS)
C
System dynamics modelers (WUSTL)
F
E
Core modeling planning team A (USF, CCC, WUSTL) B
B
B
B
G
B
I
B
Cross-stakeholder team (TBD)
J
C
H
A. Problem discovery or “scoping”
F. GMB: model formulation and refinement
B. Core modeling team planning and training
G. Model refinement and initial policy analysis
C. Recruitment of group model-building (GMB) participants
H. GMB: Policy analysis
D. GMB: dynamic hypothesis conceptualization
I. Model revision and policy analysis
E. Model formulation
J. Transfer of model ownership
Planning and training
Participant recruitment
Group model-building
System dynamics modeling
Example: “Detailed Agenda”
Example: “Facilitation Manual”
Contents 1. Introduction to CBSD 2. Group Model Building and CBSD Process 3. Engaging Communities 4. Problem Scoping and Identification 5. Core Modeling Team Planning, Training
6. Group Model Building Workshops and Facilitation 7. Model Refinement, Integration, Formulation, Analysis 8. Implementation and Evaluation
Chapter 6 “Group Model Building Workshops and Facilitation”
Setting the Frame Fundamentally, GMB planners are offering people a different way to look at things; and that can be a gift and something terrific, but getting there can be frustrating and disorienting. The GMB workshop “frame” includes everything from the physical layout of the room to the authenticity of the workshop facilitation team. When it comes to GMB workshop success, the most important factor, more so than skill, is having the right attitude.
Credit: P.S. Hovmand, WUSTL
Example: “Public GMB Agenda”
Example: “Facilitation Manual Scripts”
GMB Facilitation Tips • • • • • • •
Connect with participants (e.g., learn names). Stay neutral and balanced. Use physical space (e.g., conversation flow). Work the room during small group exercises. Point and name objects (e.g., feedback loops). Don’t be in a rush to fill in silence. Know what you’re trying to do at each point. Credit: P.S. Hovmand, WUSTL
Contents 1. Introduction to CBSD 2. Group Model Building and CBSD Process 3. Engaging Communities 4. Problem Scoping and Identification 5. Core Modeling Team Planning, Training
6. Group Model Building Workshops and Facilitation 7. Model Refinement, Integration, Formulation, Analysis 8. Implementation and Evaluation
Chapter 7 “Model Refinement, Integration, Formulation, and Analysis”
Why Model? CBSD emphasizes educating and building capacity over multiple projects as a means to not only engage and mobilize communities for change during the early phases with informal maps but also to build the motivation and capacity for model specification, testing, and analysis for rigorous formal models and computer simulations; and the ability to convey insights to mobilize action. In CBSD, the expert modeler is teacher and guide, helping people see what the modeler sees; succeeding here means always being aware of how to see and apply the principles of system dynamics to gain the greatest insights. Credit: P.S. Hovmand, WUSTL
Example: Colorectal Cancer Prevention Community Committee (Tampa, FL) • Understand colorectal cancer (CRC) screening challenges as a complex adaptive system • Use of participatory group model building with stakeholders and system dynamics modeling and simulation
Overview of Group Model Building Workshops for CRC Screening Connection Circles
Session 1
Causal Loop Diagrams
Stock and Flow Diagram
Preliminary Simulation Model
Session 2
Session 3
Informal Causal Maps Session 1: Connection Circles
Session 1: Causal Loop Diagrams
Overview of Group Model Building Workshops for CRC Screening Connection Circles
Causal Loop Diagrams
Stock and Flow Diagram
+
Preliminary Simulation Model
Family Support Fear
+
-
+
R
R High-Risk (Family History)
+
-
- + People Being Screened Knowledge/ Awareness + + + Positive Social Norms
-
+ +
Positive Screenings
+
Treatment
+ +
+
+
+
+
GI Specialists
Out-of-Pocket Costs R
+ Access to Care +
Session 1
People Waiting for Treatment
B B
+
Diagnostics
-
B
Provider/Staff Emphasis
+ R
Screening
+
People Waiting for Diagnostic Colonoscopy
Structural Barriers
Insurance
Session 2
Session 3
+
Family Support Fear
-
Knowledge/ Awareness
+ + Positive Social Norms
-
+ +
-
Positive Screenings
Diagnostics
B
+
+
+
+
+ Out-of-Pocket Costs + Access to Care + Insurance
Structural Barriers
Treatment +
B
R
People Waiting for Treatment
-
B
+
People Waiting for Diagnostic Colonoscopy
-
+
Provider/Staff Emphasis
+ R
R High-Risk (Family History) + - + People Being Screened Screening
+
+
+
-
+
R
GI Specialists
-
-
High-Risk (Family History)
+
Fear
+
+ People Screened Positive Screenings
+ -
+ Screening
+ +
Provider reluctance
R
+
+ Positive Social Norms + -
UDS and HEDIS +
-
People Waiting for Treatment
GI Specialists, Facilities, and Support Capacity
Out-of-Pocket Costs
Treatment
+
R +
+ -
+
-
Insurance (private, ACA)
-
-
Access to Care
+ National Screening Guidelines
-
+
+
+
+
+
B
+
Provider/Staff Emphasis
+
People Waiting for Diagnostic Colonoscopy Diagnostics
B
B -
+
+
-
-
+
+
Patient Knowledge/ Awareness
+
+
People referred to screening +
-
+
+
Pre-screening and referral
-
Support
+
Structural Barriers
+
Overview of Group Model Building Workshops for CRC Screening Connection Circles
Causal Loop Diagrams
Stock and Flow Diagram
+
Preliminary Simulation Model
Family Support Fear
+
-
+
R
R High-Risk (Family History)
+
-
- + People Being Screened Knowledge/ Awareness + + + Positive Social Norms
-
+ +
Positive Screenings
+
Treatment
+ +
+
+
+
+
GI Specialists
Out-of-Pocket Costs R
+ Access to Care +
Session 1
People Waiting for Treatment
B B
+
Diagnostics
-
B
Provider/Staff Emphasis
+ R
Screening
+
People Waiting for Diagnostic Colonoscopy
Structural Barriers
Insurance
Session 2
Session 3
Net Change in Patient Knowledge and Awareness
+
Patient Knowledge and Awareness
Net Change in Family Support
Effect of Patient Knowledge and Awareness on Avg Delay to Screening
+
+
Effect of Family Support on Avg Delay to Screening -
Effect of Fear on Avg Delay to Diagnositc +
Net Change in Fear
+ Effect of Fear on Avg Delay to Screening
-
Family Support
+
Fear
-
Avg Delay to Diagnostic Colonoscopy
+
+ B1
Avg Delay to Screening
-
-
Effect of Positive Social Norms on Patient Knowledge and Awareness
Effect of Patient Knowledge and Support on Pre-Screening and Referral
+
Pre-screening and referral
+
Effect of Positive Social Norms on Family Support
+
+
Positive Screenings
People referred to screening
+
No Screening Proportion pre-screened and referred Total Population + Needing to be Effect of Positive Screened Social Norms on Pre-Screening and Referral Effect of Positive Social Nroms on Prop Screened + +
Positive Social Norms
Negative Screenings
+
-
Diagnostics
No Diagnostics
- +
Prop Screened
+
Prop Positive -
+
+ Effect of Fear on Prop Screened
Effect of Prop Screened on Social Norms
People Waiting for Treatment
Treatment -
No Treatment
+
R1 Net Change in Positive Social Norms
People Waiting for Diagnostic Colonoscopy
Avg Delay to Treatment
+
What kinds of questions can the CRCS strategic model be used to answer? Types of question
Examples of questions that the CRCS model could answer
Retrospective explanations of system behavior over time
• What were some of the key facilitators that made CRC screening increase early on? • What were some of the key barriers that made CRC screening ‘level off‘ over time?
Prospective strategic design and planning
• What are the plausible scenarios for achieving our goals? • Where are the leverage points for bringing about gains in CRC screening?
Monitoring, evaluation, and learning
• What indicators should we be looking at to track progress, detect risks of failure, etc.?
What kinds of questions CANNOT the CRCS strategic model be used to answer? Types of question
Examples of questions that the model CANNOT answer
Predicting precise numeric estimates
• How many people will be demanding CRC screening in 3 years? • How much will we need to spend to achieve our goals?
Operational details about implementation tied to a leverage point
• Which ‘marketing mix’ (product, price, place, promotion) should we create? • What skills should we train doctors, nurses, and community health workers in?
User Parameterized Models* Key fact: dynamic equilibrium implies inflow = outflow
Given: 1. Value of inflow 2. Value of hazard rate 3. Outflow = Hazard rate x Stock Find: What is the stock when the system is in dynamic equilibrium? http://sfrc.ufl.edu/extension/ee/climate/wp-content/uploads/SEE_2a.pdf
Solution: Stock = Inflow/Hazard rate
*Winch, G. W., & Arthur, D. J. W. (2002). User-parameterized generic models: a solution to the conundrum of modelling access for SMEs? System Dynamics Review, 18, 339-357.
Overview of Model
Overview of Model
Potential Leverage Points
Referrals and Screenings
Mapping of leverage points Fear
Fear, patient knowledge, family support, and positive social norms
Distribution of simulations combining all interventions relative to control •
All leverage points are assumed to have the same effect size (75% improvement or strong effect) for comparison purposes
•
Three basic clusters
Percent improvement ranked from highest (top) to lowest (bottom) •
Reducing fear has the single largest overall effect, followed by improving positive social norms
•
Patient knowledge and awareness and family support have marginal impacts on their own or in combination
Online interface
https://exchange.iseesystems.com/public/psh/prc-screening
Contents 1. Introduction to CBSD 2. Group Model Building and CBSD Process 3. Engaging Communities 4. Problem Scoping and Identification 5. Core Modeling Team Planning, Training
6. Group Model Building Workshops and Facilitation 7. Model Refinement, Integration, Formulation, Analysis 8. Implementation and Evaluation
Chapter 8 “Implementation and Evaluation”
Implementation Implementation—putting some innovation such as an intervention or policy into actual use—is one of the main motivations for doing CBSD. An assumed consequence of CBSD is that accumulated community capacity leads not only to model-based insights but also community mobilization to implement the recommendations. In CBSD, some insights derive from less formal models (e.g., causal loop diagrams) and are implemented relatively quickly; other insights derive from more formal computer simulation models and require a strategic planning approach for implementation and evaluation.
Image: Stuart Miles / FreeDigitalPhotos.net
Community Based-System Dynamics/-Social Marketing “CBPM for Systems Change” framework represents one approach for overcoming the implementation challenge in system dynamics modeling, through the use of social marketing, which integrates marketing concepts with other approaches to influence behaviors that benefit the greater social good.
Evaluation Evaluation of CBSD workshops can take many forms, from informal assessments of “hopes and fears” (right) to more formal pre-post followup surveys of processes & outcomes. Major evaluation challenge: GMB workshops tend to be highly customized, and a strong component is tied to attitude and skills of facilitators. CBSD is itself a dynamically complex system. This book (Hovmand, 2014) is an attempt to provide a more explicit account of CBSD, underlying philosophy, and potential outcomes; and this user guide is an attempt to provide a real-world example of CBSD.
“Hopes” “Fears”
For More Information On: Community-Based System Dynamics (CBSD)
Community-Based Prevention Marketing (CBPM)
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